In this video I share a straight forward approach to the diagnosis of thoracic outlet syndrome and discuss some of its attributes.
Thoracic outlet syndrome is often regarded as extremely rare, but this could not be further from the truth. It is very common. But, the extreme vascular cases are rare, and because these are the only ones that show up unequivocally on imaging tests, they are also the ones that tend to be caught in generalized clinical settings.
Neurogenic TOS usually manifests as non-specific but often excruciating pain in the neck, chest, shoulderblades, arms or hands during or after arm-loading. This can be carrying croceries, cleaning windows or ceilings, cooking, carrying backpacks, or in less dire circumstances, gym exercises such as bench pressing.
A normal cervical MRI and negative Spurling's test in the co-presence of diffuse- or non-specific neck, chest, shoulder, or brachialgia that worsens with arm-loading should put TOS as a primary tentative diagnosis on your list of differentials.
Unfortunately, electrodiagnostic and imaging studies tend to be normal in TOS, even in severe sufferers (Rousseff 2005), and especially sole neurogenic TOS. Thus, it is a diagnosis requiring clinical suspicion and knowledge about its manual clinical workup. Clinical confidence is also needed, as one would be stilling a relatively serious diagnosis without support from your colleagues in the neurophysiology or radiological departments. I forgot to mention this in the video, but MRI of the brachial plexus is also useless in the identification of TOS. It can, however, be useful in the exclusion of schwannomas, root avsulsions, and similar.
20 фев 2021
